Provider Demographics
NPI:1083083596
Name:VINCENT, CAITLIN B (LMFT CDP)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:B
Last Name:VINCENT
Suffix:
Gender:F
Credentials:LMFT CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL AVE S
Mailing Address - Street 2:SUITE 10
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2175
Mailing Address - Country:US
Mailing Address - Phone:425-226-5062
Mailing Address - Fax:
Practice Address - Street 1:200 MILL AVE S
Practice Address - Street 2:SUITE 10
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2175
Practice Address - Country:US
Practice Address - Phone:425-226-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60568982106H00000X
WACP60457201101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)